Wednesday, January 30, 2013

My Birth Story - Part 2

 Having a Natural Unmedicated Childbirth After a Cesarean is Possible 
 My Personal Journey

My Quest for a VBAC

Never Quit. Stick to the fight when you’re hardest hit.

     This was my motto in my 7th grade yearbook (and that was ages ago!), but I still hold this saying close to my heart because I believe failure shouldn’t stop us from trying. It should just make us want to try harder.
     My first childbirth experience was not exactly a complete failure – because I received my reward - a beautiful baby who was perfectly healthy, and that I am thankful for. But my method of delivery and the process that led to it made me feel that I could have done better. It wasn’t my desired outcome and how I wished then that I could go back in time to change things.
     I am glad though that I already knew about VBAC (Vaginal Birth After Cesarean) even though having a C-section usually places women at a dead end. We are often led to believe that the saying “once a Cesarean, always a Cesarean” holds true. But we need to find out the facts first and see if this indeed applies to us. It may for some, but surely not for all.
     During my first pregnancy I had read about VBAC in passing. I wasn’t expecting to end up having a C-section so I thought I wouldn’t spend my time reading up on it so much. But I knew what it was about. And my curiosity just grew as soon as I came home from the hospital after giving birth to Audrey.
     When I had some time on my hands, I would read up on what went wrong with my childbirth experience and what my chances were on having a VBAC. It was quite a challenge trying to learn all this since I lacked sleep and was very preoccupied with the new baby, but I had to make an effort. I was so convinced that I really could have had a normal birth and I wanted to bring up the possibility of having a VBAC for my next pregnancy to my doctor during my postpartum checkup.
     I began my research by looking through my operating room notes from the hospital. The pre-operative diagnosis stated that there was an Arrest of Cervical Dilatation secondary to Uterine Dysfunction (Incoordinate Uterine Contractions) – meaning my cervix failed to progress dilating because my contractions were not synchronized. Apparently, labor induction can cause abnormal uterine contractions that not only fails to do the job of dilating the cervix but also results in prolonged labor (aha! sounds familiar).

     Check out a section in this book by P. McCall Sellers - Midwifery, Volume 2 about Disordered Uterine Action and Augmentation of Labor:

"...The intensity, the rate and the duration of the uterine contractions are irregular and the contraction wave is uneven and does not reach all parts of the uterus simultaneously. There is often also a raised resting tone. This type of uterine action results in uneven and painful uterine contractions, which are ineffective in dilating the cervix and therefore cause prolonged labor.”

      And a C-section has an increased chance of happening in first time mothers (like I was), especially if the induction is done before the baby and the cervix is ripe and ready. Studies show that this usually happens if induction is done before 39 weeks.

 “The American College of Obstetricians and Gynecologists (ACOG) reports that 20 percent to 40 percent of labors are induced—a number that, along with C-section rates, has doubled in the last decade. A 2005 ACOG study determined that inducing first-time mothers was directly associated with an increased risk for C-section: The rate was 12 percent for spontaneous labor, 23.4 percent for medically indicated inductions and 23.8 percent for elective inductions.”

- From an article published in by Jeanne Faulkner, R.N., a labor and delivery nurse and mother of four in Portland, Oregon

     If you were able to read part 1 of my birth story, the first reason why I think I could have had a normal birth was because my labor was induced for no apparent reason. It was just done upon my doctor’s recommendation which I should have questioned then (lesson learned!). And because labor didn’t start naturally, I was convinced the outcome would have been different if it did.
    Second, I knew I was a good candidate for a VBAC because my C-section incision was a low transverse cut (bikini cut). So the risk of uterine rupture was significantly lower. (And no, it does not mean your uterus will explode – there is just a possibility that the scar will separate and tear during labor or birth, causing bleeding and shock, and an emergency surgery will be needed). I know it sounds a bit scary or even dangerous, but I chose to focus on the benefits rather than the risks. After all, it occurs rarely and in only less than one percent of women laboring for a VBAC based on reports by the National Institutes of Health Consensus Development Program. I just prayed I wouldn’t fall under the one percent who would actually experience it.
   When I finally went for my postpartum checkup and asked my doctor then what my chances were for a VBAC for my second baby, I was told that I failed to progress because I had CPD or Cephalopelvic Disproportion - meaning my pelvic bones were too small for a baby to fit through them. So that meant that I cannot have a normal birth and my only option was to have a repeat Cesarean. 
    I didn't want to accept this diagnosis because as far as I was concerned, there was no actual proof that my pelvic bones were too small. I didn't even fully dilate to 10 cms during the birth and attempt to push the baby out. If I did and Audrey didn't fit, maybe I would have believed it. I have also read that only a very small percentage of women actually have this condition, and yet it is a very common diagnosis nowadays. A pelvic xray or a physical examination that measured pelvic size was not done either to confirm that I had CPD, so there was just no way to prove this.  This was the third reason why I believed that I was a good candidate for a VBAC - there simply wasn't enough evidence to pin me down to a repeat Cesarean.

 I continued to research and read about successful vaginal births after a Cesarean section,
and it just encouraged me to try it the next time around.

     It was then less than a year and a half after Audrey's birth when my husband and I were pleasantly surprised with another pregnancy. Prior to this, I had already asked for a second opinion from another ob-gyn during a general checkup about my chances of having a normal birth the second time around. This doctor said I cannot do a VBAC because of the arrest of cervical dilatation that happened during labor. According to her, it would be difficult to try for a VBAC because I already failed to progress before. She also requires a waiting period of three years before trying for a vaginal birth after a C-section.
     And even though Doctor no. 1 and Doctor no. 2 had already told me that what I wanted wasn’t possible - at least in their opinion – this didn’t stop me from choosing to attempt a VBAC. I just focused on my goal and hoped to find a doctor who would be open and willing to help me.
     So as soon as I found out that I was pregnant again, I decided to go to yet another doctor to get a third opinion. This doctor also was not sure if she could help me with trying for a vaginal birth this time around because she was concerned with the failed induction the first time. She said an arrest of cervical dilatation will lessen my chances for a successful VBAC because I already had a trial of labor and it failed. It was pretty much the same answer every time - which was a no, but I wasn’t about to give up. There has got to be a doctor out there who thinks differently and actually knows that a VBAC is indeed possible with me.
     I did not stop looking for an ob-gyn who would be open to my birth wishes because I knew in my heart that I could do a VBAC, and all the information that I was able to gather while reading backed it up. And thank God the fourth doctor I went to was open and very positive. She was the fourth reason why I knew that a normal birth for me was possible. She only required one year after the previous C-section before getting pregnant in order to perform a VBAC. And when I relayed the reasons for my previous C-section, she said that one pregnancy or birth is different from another. What happens during delivery in each pregnancy will not always be the same.
     When I asked about induced labor as compared to natural labor, she said that they are very different from each other and yield different results. And because I only dilated up to 5 cms then and didn’t have a chance to push Audrey out, there really was no actual proof that a baby wouldn’t fit through my pelvis. (In my mind I thought - Exactly! - it felt good to actually hear this from a doctor at last!).
    I loved the fact that my operative notes did not give this doctor a worried look or make her say that it’s not possible. It seemed as though what was written on it practically didn’t matter anymore. I was so relieved and excited. Finally!!!
     And though it still wasn't a hundred percent sure that my attempt to do a VBAC was going to be successful, being given the chance to actually try for a natural birth was good enough for me. And you guessed it - I decided to stay with this doctor and I am so glad that I did. 

     Join me next time as I share about my second pregnancy and how I was able to successfully labor without anesthesia.

References and Links that you might find interesting:

About VBAC:

About Uterine Rupture:

About CPD:

About Labor Induction:

Monday, January 28, 2013

We Are All Special


     Alright, alright, alright... Now that you know that I came out of my mom's tummy in a not so natural way and kind of gave her a hard time - I think you should also know that my mom and dad said that I more than made up for it by being an easy baby :) 

Yes, I was so good I grew angel's wings! (wink wink)

     And no matter which way I made my entrance into this world, they were so thankful that I did. I was precious and special in their sight. The love they felt for me was over and beyond what they thought they were capable of. And that makes me feel all warm and happy inside :)

"Children are a gift from the Lord"
                                                                 - Psalm 127:3

Photos by The Picture Company

Thursday, January 24, 2013

What Matters

    A few days before planning to post part 2 of my birth story, I accidentally deleted it and blogger auto saved it! (oh my! stress!) So that meant that my post was now empty. My work was GONE. All efforts in finding it somewhere in the internet was useless. It had disappeared into thin air. I would just have to rewrite it all (and well, make you wait a bit). That’s how my day started then.

    When my girls woke up I thought, now onto more important things… Time to breastfeed Natalie, give her a bath, prepare Audrey’s breakfast, pray with my husband before he leaves, eat (but with the butterflies in my stomach, I really couldn’t), send out work emails, coordinate schedules with clients, read to the girls… my list goes on. You see, I can’t really write unless it’s the wee hours of the morning, or late at night. But I was in a bit of a panic and thought I can't finish my post if I don't use up more time during the day. Except there are so many things that preoccupy me – and they are the more important things. I enjoy writing, I always have, but my priority is taking care of my family, my household and my work. So I had to shift my focus quickly – and believe me it was HARD. But I knew it needed to be done or nothing else would be.

    And so my seemingly stressful day began - or so I thought. My 3 month old gives me a smile as I pick her up for a feeding and I swear the stress was washed away. Afterwards, I put Audrey’s breakfast in front of her and she says, “Thank you Mum” (oh happy day!). I think my sentences are starting to rhyme now hahaha! I really had to put my worries aside so I could focus on what’s more important. I just prayed that what I wrote would still be unearthed from my memory bank somehow. And if not, maybe I’ll be able to write something better. Who knows... But what I do know is that when I let go and choose what matters more, my day is made. 

Monday, January 21, 2013

My Birth Story - Part 1

     Having a Natural Unmedicated Childbirth After a Cesarean is Possible 
 My Personal Journey

       Hi Everyone! I just wanted to share my wonderful and incredible birth experience with my second baby. I had a natural childbirth without anesthesia after having a C-section with my firstborn - and in just a span of two years and a month. I would like to encourage other mothers and expectant moms out there (and even those planning to be a mom in the future) to consider the possibility and benefits of having a normal delivery and especially one after a Cesarean. This is quite a long and detailed story so I've decided to break it into a couple of sections. Let me start with my first pregnancy and birth experience, and how it has led me to seek other options the second time around.

Audrey: My First Birth Experience

My First Pregnancy: Audrey at 8 months in the tummy
        More than two years ago, I gave birth to my beautiful baby girl Audrey. She was just an adorable bundle of joy and everything that I had prayed for and more. However, my birth experience was just the opposite. I was hoping to give birth naturally and looked forward to an easy recovery but things didn't turn out the way I'd hoped. I ended up having a C-section after 33 and a half hours of labor and an asthma attack in the operating room. I endured four hours of vomiting every fifteen minutes while in recovery, and was nauseated and dizzy after waking up from my sleep. And of course to top it all off, I had to deal with the very uncomfortable and painful C-section wound afterwards. 
       Giving birth via C-section not just made recovery difficult and inconvenient for me, it also made me feel like I was cheated out of the real birth experience. And this feeling was valid, especially after discovering so many things that convinced me that I really had a chance to do a normal birth.
        First, my labor was induced with no apparent reason but that I was in my 38th week of gestation, I was almost 3 cms dilated and that baby was already 6 lbs and 3 ounces. According to my doctor, if we induced labor I can already give birth before my baby gets any bigger, thus increasing my chance of having a normal delivery. This was brought to my attention during a routine checkup at my doctor's clinic and she recommended that I already check in the next day for induction. With my desire to see Audrey already and get rid of the very uncomfortable backache I was experiencing, I agreed. I thought that the induction had a good chance of working anyway. Had I known better then, I would have said no and waited till baby was really ready to come out. I practically signed myself up for a date in the operating room by agreeing to my doctor's suggestion. I later discovered after reading and researching that first time mothers whose labors were induced had an increased possibility of ending up in a C-section delivery. I will share more of what I found out in the next part of my birth story.
       So here is a blow by blow account of what happened then... I checked into the labor room at about 1pm on Sunday and was given oxytocin intravenously by 2pm. My husband and I waited in anticipation at what would take place and when baby would come. After a couple of hours and a pretty consistent show of contractions, I had an internal exam and was at 4 cms. By that evening I was at 5 cms and thought that my body was showing so much promise. Contractions were consistent and strong, and my cervix was dilating as expected. Baby would come soon. The nurses have even started offering me epidural anesthesia since the contractions were already pretty strong but I kept saying no. As far as I was concerned, the contractions weren't that painful and I've had worse pain with dysmennorhea. I also didn't want to ask for any drugs unless I absolutely needed it. 
       Later that evening when my doctor came in to check on me, I was still at 4-5 cms. She thought I would give birth a few hours after, even telling the resident doctors to expect delivering soon. But it didn't happen. Everytime they would do an internal exam, I would still be at 4-5 cms. Baby's head was not even engaged (meaning settled at the pelvis). And so my doctor told them that if I didn't show any progress until the next morning, to allow me to have a light meal so as to sustain me through labor and the next day. 

      So I slept through the night and had my breakfast. During another internal exam that morning, the situation remained the same. Cervix was at 4-5 cms and baby's head was at Station -2, even bouncing back up. (Station 0 is the middle of the pelvic inlet and a negative number means that the head of the baby is still above it or floating. Each number represents a centimeter so in this case, the head is still 2 cms away). Audrey just wouldn't go down no matter how many times my husband and I pleaded for her to come out already. 
        I decided to walk and walk and walk around the delivery room, hoping to help speed things up and bring baby down. My doctor had already given orders to pop the bag of waters in an hour to help strengthen the contractions and open up the cervix more. But it wasn't necessary as I felt a slight gush of water leaking already. By the 24th hour my water had broken and it gave me more hope that perhaps I would finally dilate fully. But everything remained the same. Contractions were strong and consistent and my cervix was still at 5 cms, with Audrey's head still at Station -2. 
       Nothing changed after about 33 hours of laboring so my doctor finally said the dreaded words - "If there's still no progress within an hour, we will need to do a C-section." I looked at my husband and felt sooo disappointed in myself. I was so sad and on the verge of tears because this was not what I had wanted at all - and I couldn't do anything about it anymore. Even though Audrey was doing ok with no sign of stress at all, I didn't want to take any chances. I had been laboring for too long and it would eventually be bad for her so I had to consent to this decision. 
       I was prepped and after about an hour, Audrey was out. I did not even get to see the birth because I had to be knocked out. And when I was woken up, I could hardly breathe - like I was having a nightmare of some sort. I only actually stopped feeling that way when my husband placed Audrey in my arms and we attempted to latch her onto me. We even took photos and those few minutes were wonderful. When she was taken away from me and I was wheeled into the recovery room, I remember going back to catching my breath. I was back to feeling awful again. I just kept vomiting and was so dizzy. Only the presence of my baby calmed me down and I looked forward to the time when they would bring her to me for a feeding... And I thought to myself, I am never having a C-section ever again. Not if I can help it.
        If it were solely up to me (and all conditions were good physically), I would definitely not opt for a C-section, and a repeat Cesarean at that. My experience clearly showed that there was an unnecessary medical intervention before the baby was ready, resulting in an unplanned (and unwanted) C-section. This was a mistake that could have been avoided. 
      And although my baby and I were safe despite everything that had happened, the inconveniences and pain that I had to go through related to the C-section were enough to push me into trying for a different birth experience the next time around. 

Enduring all the pain was difficult but worth it.
I'm still thankful because
I was blessed with a beautiful and healthy baby girl.

My newborn Audrey
                                                 Photo courtesy of Jamie Marcelo

Fresh flowers for the new mommy (who's stuck in bed)
from the new daddy :)
Five day old Audrey
      My next post is about my quest for a VBAC (Vaginal Birth After Cesarean). I was definitely on a mission to pursue a better option rather than an elective repeat C-section. My discoveries proved to be very interesting and even educational. How I wish I knew then what I know now.

References used to explain some terminologies: The Pregnancy Book and The Birth Book by William Sears, M.D. and Martha Sears, R.N.

Monday, January 7, 2013

Baby Sister in the Tummy

I'm a Big Sis!
When baby sister was still in Mama's tummy, we had a photo shoot to capture the memories of the pregnancy together with me, Mama and Dada. It was a fun afternoon and I gave baby sister in the tummy lots of bear hugs! Here are some of our pictures.

Sandwiched by Mama and Dada's kisses!

 I think I can hear and feel baby sister!

Our family photo :)

That's baby sister in there at 35 weeks old.

Oops, I think baby sister is a bit heavy now Mum! 

Me and Mama almost tummy to tummy!

Had so much fun that day! I couldn't wait for my new playmate to arrive then  
and now my baby sister Natalie is here!:)
Thank you Tita Sheila for taking our awesome photos!